人类免疫缺陷病毒耐药性对低收入和中等收入国家儿童人类免疫缺陷病毒感染治疗的影响
Impact of Human Immunodeficiency Virus Drug Resistance on Treatment of Human Immunodeficiency Virus Infection in Children in Low- and Middle-Income Countries.
作者信息
Siberry George K, Amzel Anouk, Ramos Artur, Rivadeneira Emilia D
机构信息
Office of the US Global AIDS Coordinator, US Department of State.
Prevention Care and Treatment Division, Office of HIV/AIDS, Global Health Bureau, US Agency for International Development.
出版信息
J Infect Dis. 2017 Dec 1;216(suppl_9):S838-S842. doi: 10.1093/infdis/jix407.
Abstract
Children living with human immunodeficiency virus (HIV) in low- and middle-income countries (LMICs) experience higher rates of virologic failure than adults. Human immunodeficiency virus drug resistance (HIVDR) plays a major role in pediatric HIV treatment failure because nonsuppressive maternal antiretroviral therapy (ART) during pregnancy and breastfeeding as well as infant antiretroviral prophylaxis lead to high rates of pretreatment drug resistance to regimens most commonly used in children living with HIV. Lack of availability of durable, potent drugs in child-friendly formulations in LMICs and adherence difficulties contribute to acquired drug resistance during treatment. Optimizing drugs available for treating children living with HIV in LMICs, providing robust adherence support, and ensuring virologic monitoring for children receiving ART are essential for reducing HIVDR and improving treatment outcomes for children living with HIV in LMICs.
摘要
在低收入和中等收入国家（LMICs），感染人类免疫缺陷病毒（HIV）的儿童比成人经历病毒学失败的比率更高。人类免疫缺陷病毒耐药性（HIVDR）在儿童HIV治疗失败中起主要作用，因为孕期和哺乳期母亲抗逆转录病毒疗法（ART）未达到抑制病毒的效果，以及婴儿抗逆转录病毒预防措施导致感染HIV儿童对最常用治疗方案的治疗前耐药率很高。在LMICs缺乏适合儿童剂型的长效、强效药物，以及依从性困难，导致治疗期间出现获得性耐药。优化LMICs中可用于治疗感染HIV儿童的药物、提供有力的依从性支持，以及确保对接受ART的儿童进行病毒学监测，对于降低HIVDR和改善LMICs中感染HIV儿童的治疗结果至关重要。
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